Transurethral endoscopic approach for large bladder diverticula: Evaluation of a large series

Abstract

Objective: To present the results of the largest series of patients with bladder diverticula > 4 cm managed with an endoscopic approach and give tips about the execution of the procedure. Materials and methods: Data of male patients undergone the endoscopic approach for an acquired bladder diverticula > 4 cm from December 2004 to August 2018 were prospectively collected and retrospectively analyzed. The description of the monopolar and bipolar techniques are provided. The success of the procedure was defined as the reduction of the diverticula for more of the 80% of its initial diameter documented at the 3- months follow-up imaging. Continuous variables with nonparametric distribution were compared using the Mann-Whitney test, while frequencies of categorical variables were compared between groups by Fisher’s exact test with significance level set at 0.05. Results: Thirty-nine patients with a mean (+/- SD) age at surgery of 69.4 ± 8.8 years were enrolled, for an equal number of diverticula managed. The mean diverticular size was 75.1 ± 24.5 millimeters. The mean operative time was 65 ± 21.9 minutes including the prostate surgery. Twelve patients (30.8%) were managed with bipolar energy, the others with monopolar. The success of the procedure was achieved in 30 patients (76.9% - 7 bipolar and 23 monopolar - p = 0.66). Conclusions: The endoscopic approach might be considered as a useful option for patients with a large bladder diverticulum who are at risk for major or laparoscopic procedure.

Multiple Bladder Diverticula Presenting in an 82-Year-Old Congolese Male

“…To refine the diagnosis, further explorations are often required: urethrocystography and urodynamic screening. The abdominal CT scan is often performed especially when there is a suspicion of an intradiverticular mass or a malignant origin or complication [1,14,15].…”

“…Diverse therapeutic approaches have been developed for bladder diverticulum management. While open surgery is widely preferred by surgeons for diverse reasons, the laparoscopic and transurethral endoscopic approaches are little by little supplanting it [10,14,18].…”

“…The extravesical approach is reserved for patients with large diverticula associated with peridiverticular adhesions or inflammation. The laparoscopic approach, which offers the benefits of minimally invasive surgery, may also be used [3,4,10,14,18]. Endoscopic fulguration offers comparatives and satisfactory results in the management of acquired diverticula larger than 4 cm according to Pacella et al [22].…”

Complex vesical diverticulum, an unusual cause of obstructive uropathy

“…However, in some cases, the diverticular size is significant to the point of compromising adjacent anatomical structures. 2 It also can be related to urinary tract infections, stone formation, incomplete voiding, or association with squamous neoplasia due to chronic mucosal irritation. They can also cause vesicoureteral reflux, urinary retention, or ureteral obstruction.…”

Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach

“…Open bladder diverticulectomy via a transvesical or extravesical approach has been the gold-standard surgical treatment for BD for many years. Alternatively, transurethral fulguration with or without neck incision has been proposed for small BD, and for large BD in patients who are unfit for major surgery [2] , [3] .…”